Research Article
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Crush versus sharp injuries in spaghetti wrist trauma: Analysis of 13 years of experience

Year 2024, Volume: 41 Issue: 4, 707 - 712, 31.12.2024

Abstract

Spaghetti wrist injury pertains to profound volar wrist lacerations with the potential to disrupt a complex interplay of anatomical structures. In our study, we wanted to highlight the importance of etiological factors that have not been previously investigated for this type of injury. Patients diagnosed with spaghetti wrist injury between 01.01.2010-01.01.2023 who subsequently underwent surgical intervention at our institution were identified from the database of our institution and relevant data has been recorded. Contact information for all patients was extracted, and patients were invited for follow-up examinations. A comprehensive hand examination was conducted for patients attending the follow-up assessment. Finally, patients completed the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire for a comprehensive assessment. Fifty-three patients were included in our study. The mean age of the patients was 44. The ratio of females to males is 7/46. The mean follow-up period was 7 months. The ratio of the left hand to the right hand is 21/32. Forty-two sharp and 11 crush injuries are present. The range of motion values of sharp injuries were significantly better than those of crush injuries. Opposition results were compared with each other, but no significant difference was found. However, when intrinsic muscle function was compared, ulnar nerve function recovered significantly worse after crush injury. According to both the Semmes-Weinstein Monofilament Test and two-point discrimination, sharp injuries healed with significantly better sensory outcomes. DASH questionnaire scores were compared, and no significant difference was found. Sharp injuries showed significantly better functional results than crush injuries. Our study contributes substantively to the existing literature on spaghetti injuries, particularly by examining previously unexplored areas such as injury aetiology and presents comprehensive findings on these subjects.

References

  • Jarvik JG, Dalinka MK, Bruce J. Hand Injuries in Adults. Semin Roentgenol. 1991 Oct;26(4):282–99.
  • Smith ME, Auchincloss JM, Ali MS. Causes and consequences of hand injury. The Journal of Hand Surgery: British & European Volume. 1985;10(3):288–92.
  • Bukhari AJ, Saleem M, Bhutta AR, Khan AZ, Abid KJ. Spaghetti wrist: management and outcome. J Coll Physicians Surg Pak. 2004;14(10):608–11.
  • Puckett CL, Meyer VH. Results of Treatment of Extensive Volar Wrist Lacerations The Spaghetti Wrist . Plast Reconstr Surg. 1985;75:714–9.
  • Noaman HH. Management and functional outcomes of combined injuries of flexor tendons, nerves, and vessels at the wrist. Microsurgery. 2007;27(6):536–43.
  • Yazdanshenas H, Naeeni A, Ashouri A, Washington E, Shamie A, Azari K. Treatment and Postsurgery Functional Outcome of Spaghetti Wrist. J Hand Microsurg. 2016 Aug 17;08(03):127–33.
  • El-Lamie KK, Younes TB. Spaghetti wrist: Good prognosis with adequate surgical technique and early physiotherapy. Egypt Journal of Plast Reconstr Surgery. 2010;34(2):161–6.
  • Jaquet JB, Van Der Jagt I, Kuypers PDL, Schreuders TAR, Kalmijn S, Hovius SER. Spaghetti wrist trauma: Functional recovery, return to work, and psychological effects. Plast Reconstr Surg. 2005 May;115(6):1609–17.
  • Mafi P, Beikpour H. Management And Results Of Extensıve Volar Wrıst Laceratıons: “The Spaghettı Wrıst” In 124 Patıents Durıng A 5 Year Perıod In 15 Th Khordad Hospıtal Tehran. Vol. 20, Medical Journal. 2006.
  • Bircan C, El O, Akalin E, Bacakoglu AK, Gulbahar S, Sahin E. Functional outcome in patients with zone V flexor tendon injuries. Arch Orthop Trauma Surg. 2005 Jul;125(6):405–9.
  • Rogers GD, Henshall AL, Sach RP, Wallis KA. Simultaneous laceration of the median and ulnar nerves with flexor tendons at the wrist. J Hand Surg Am. 1990;15(6):990–5.
  • Kabak Ş, Halıcı M, Baktır A, Türk CY, Avşaroğulları L. Results of treatment of the extensive volar wrist lacerations: “the spaghetti wrist.” European Journal of Emergency Medicine. 2002 Mar;9(1):71–6.
  • Chin G, Weinzweig N, Mead M, Gonzalez M. “Spaghetti Wrist”: Management and Results. Plast Reconstr Surg. 1998;102(1).
  • Uysal A, Kayıran O, Cüzdan Ss, Gürsoy K, Koçer U, Aslan G. El Bilek Volar Yüz Yaralanmaları: Cerrahi Deneyimlerimiz. Turkplastsurg. 2007;15(2):109-13.
  • Mogahed Altamimy H, Taman A, Khereba W, Mustafa SA, Mustafa A, Negm AA, et al. Acute volar Wrist Injuries: Evaluation, Management and Rehabilitation. Vol. 5, Int. J. of Life Sciences. 2017.
  • Demirdover, C., Ozturk, F. A., Yazgan, H. S., Yogurtcu, N., Sevindik, M., Vayvada, H. Surgical treatment and functional outcomes of multicomponent soft tissue injuries of the wrist. Hand surgery and rehabilitation. 2018;37(3);160-66.
  • Stefanou N, Kontogeorgakos V, Varitimidis S, Malizos KN, Dailiana Z. Spaghetti wrist: Transverse injury, axial incision, layered microsurgical reconstruction. Injury. 2021;52(12):3616–23.
  • Nasab SAM, Sarrafan N, Saeidian SR, Emami H. Functional outcome of flexor tendon repair of the hand at zone 5 and post operative early mobilization of the fingers. Pak J Med Sci. 2013 Jan;29(1).
  • Boynuyogun E, Ozdemir DM, Firat T, Uzun H, Aksu AE. Combined nerve, vessel, and tendon injuries of the volar wrist: Multidisciplinary treatment and functional outcomes. Hand Surg Rehabil. 2021 Dec 1;40(6):729–36.
  • Hudson DA, de Jager LT. The spaghetti wrist: Simultaneous laceration of the median and ulnar nerves with flexor tendons at the wrist. The Journal of Hand Surgery: British & European Volume. 1993;18(2):171–3.
  • Vaughn CJ, Raghavan SS, Hansen SL, Terry MJ. Obstacles to the Care of Patients With Multicomponent Volar Wrist Lacerations at a County Hospital. Ann Plast Surg. 2016 May 1;76:S238–40.
  • Yıı Nw, Urban M, Ellıot D. A Prospective Study Of Flexor Tendon Repair İn Zone 5. Journal Of Hand Surgery. 1998 Oct 1;23(5):642–8.
  • Kleinert HE, Kutz JE, Atasoy E, Stormo A. Primary Repair of Flexor Tendons. Orthopedic Clinics of North America. 1973;4(4):865–76.
  • Stefanich RJ, Putnam MD, Peimer CA, Sherwin FS. Flexor tendon lacerations in zone V. J Hand Surg Am. 1992;17(2):284–91.
  • Irwin MS, Gilbert SEA, Terenghi G, Smith RW, Green CJ. Cold intolerance following peripheral nerve injury: Natural history and factors predicting severity of symptoms. The Journal of Hand Surgery: British & European Volume. 1997;22(3):308–16.
  • Altissimi M, Mancini Gb, Azzara A. Results Of Prımary Repaır Of Dıgıtal Nerves. Vol. 16, Journal Of Hand Surgery (British. 1991.
  • Wang WZ, Miller Crain G, Baylis W, Tsai TM. Outcome of digital nerve injuries in adults. J Hand Surg Am. 1996;21(1):138–43.
  • Dellon, A. L. Sensory recovery in replanted digits and transplanted toes: a review. Journal of reconstructive microsurgery. 1986;2(02);123-29.
  • Pettengill KM, Van Strien G. Postoperative management of flexor tendon injuries. In: Rehabilitation of the hand and upper extremity. 5th ed. 2002. p. 431–56.
  • Terzis, J., Faibisoff, B., Williams, B. The nerve gap: suture under tension vs. graft. Plast Reconstr Surg. 1975;56(2);166-70.
  • Wang F, Zhang R, Liu S, Ruan H, Xu J, Kang Q. Severe spaghetti wrist injury: Should we expand the terminology from wrist to proximal forearm? Jt Dis Relat Surg. 2022;33(2):273–84.
  • Widgerow AD. Full-house/spaghetti wrist injuries. Analysis of results. S Afr J Surg. 1990;28(1):6–10.
Year 2024, Volume: 41 Issue: 4, 707 - 712, 31.12.2024

Abstract

References

  • Jarvik JG, Dalinka MK, Bruce J. Hand Injuries in Adults. Semin Roentgenol. 1991 Oct;26(4):282–99.
  • Smith ME, Auchincloss JM, Ali MS. Causes and consequences of hand injury. The Journal of Hand Surgery: British & European Volume. 1985;10(3):288–92.
  • Bukhari AJ, Saleem M, Bhutta AR, Khan AZ, Abid KJ. Spaghetti wrist: management and outcome. J Coll Physicians Surg Pak. 2004;14(10):608–11.
  • Puckett CL, Meyer VH. Results of Treatment of Extensive Volar Wrist Lacerations The Spaghetti Wrist . Plast Reconstr Surg. 1985;75:714–9.
  • Noaman HH. Management and functional outcomes of combined injuries of flexor tendons, nerves, and vessels at the wrist. Microsurgery. 2007;27(6):536–43.
  • Yazdanshenas H, Naeeni A, Ashouri A, Washington E, Shamie A, Azari K. Treatment and Postsurgery Functional Outcome of Spaghetti Wrist. J Hand Microsurg. 2016 Aug 17;08(03):127–33.
  • El-Lamie KK, Younes TB. Spaghetti wrist: Good prognosis with adequate surgical technique and early physiotherapy. Egypt Journal of Plast Reconstr Surgery. 2010;34(2):161–6.
  • Jaquet JB, Van Der Jagt I, Kuypers PDL, Schreuders TAR, Kalmijn S, Hovius SER. Spaghetti wrist trauma: Functional recovery, return to work, and psychological effects. Plast Reconstr Surg. 2005 May;115(6):1609–17.
  • Mafi P, Beikpour H. Management And Results Of Extensıve Volar Wrıst Laceratıons: “The Spaghettı Wrıst” In 124 Patıents Durıng A 5 Year Perıod In 15 Th Khordad Hospıtal Tehran. Vol. 20, Medical Journal. 2006.
  • Bircan C, El O, Akalin E, Bacakoglu AK, Gulbahar S, Sahin E. Functional outcome in patients with zone V flexor tendon injuries. Arch Orthop Trauma Surg. 2005 Jul;125(6):405–9.
  • Rogers GD, Henshall AL, Sach RP, Wallis KA. Simultaneous laceration of the median and ulnar nerves with flexor tendons at the wrist. J Hand Surg Am. 1990;15(6):990–5.
  • Kabak Ş, Halıcı M, Baktır A, Türk CY, Avşaroğulları L. Results of treatment of the extensive volar wrist lacerations: “the spaghetti wrist.” European Journal of Emergency Medicine. 2002 Mar;9(1):71–6.
  • Chin G, Weinzweig N, Mead M, Gonzalez M. “Spaghetti Wrist”: Management and Results. Plast Reconstr Surg. 1998;102(1).
  • Uysal A, Kayıran O, Cüzdan Ss, Gürsoy K, Koçer U, Aslan G. El Bilek Volar Yüz Yaralanmaları: Cerrahi Deneyimlerimiz. Turkplastsurg. 2007;15(2):109-13.
  • Mogahed Altamimy H, Taman A, Khereba W, Mustafa SA, Mustafa A, Negm AA, et al. Acute volar Wrist Injuries: Evaluation, Management and Rehabilitation. Vol. 5, Int. J. of Life Sciences. 2017.
  • Demirdover, C., Ozturk, F. A., Yazgan, H. S., Yogurtcu, N., Sevindik, M., Vayvada, H. Surgical treatment and functional outcomes of multicomponent soft tissue injuries of the wrist. Hand surgery and rehabilitation. 2018;37(3);160-66.
  • Stefanou N, Kontogeorgakos V, Varitimidis S, Malizos KN, Dailiana Z. Spaghetti wrist: Transverse injury, axial incision, layered microsurgical reconstruction. Injury. 2021;52(12):3616–23.
  • Nasab SAM, Sarrafan N, Saeidian SR, Emami H. Functional outcome of flexor tendon repair of the hand at zone 5 and post operative early mobilization of the fingers. Pak J Med Sci. 2013 Jan;29(1).
  • Boynuyogun E, Ozdemir DM, Firat T, Uzun H, Aksu AE. Combined nerve, vessel, and tendon injuries of the volar wrist: Multidisciplinary treatment and functional outcomes. Hand Surg Rehabil. 2021 Dec 1;40(6):729–36.
  • Hudson DA, de Jager LT. The spaghetti wrist: Simultaneous laceration of the median and ulnar nerves with flexor tendons at the wrist. The Journal of Hand Surgery: British & European Volume. 1993;18(2):171–3.
  • Vaughn CJ, Raghavan SS, Hansen SL, Terry MJ. Obstacles to the Care of Patients With Multicomponent Volar Wrist Lacerations at a County Hospital. Ann Plast Surg. 2016 May 1;76:S238–40.
  • Yıı Nw, Urban M, Ellıot D. A Prospective Study Of Flexor Tendon Repair İn Zone 5. Journal Of Hand Surgery. 1998 Oct 1;23(5):642–8.
  • Kleinert HE, Kutz JE, Atasoy E, Stormo A. Primary Repair of Flexor Tendons. Orthopedic Clinics of North America. 1973;4(4):865–76.
  • Stefanich RJ, Putnam MD, Peimer CA, Sherwin FS. Flexor tendon lacerations in zone V. J Hand Surg Am. 1992;17(2):284–91.
  • Irwin MS, Gilbert SEA, Terenghi G, Smith RW, Green CJ. Cold intolerance following peripheral nerve injury: Natural history and factors predicting severity of symptoms. The Journal of Hand Surgery: British & European Volume. 1997;22(3):308–16.
  • Altissimi M, Mancini Gb, Azzara A. Results Of Prımary Repaır Of Dıgıtal Nerves. Vol. 16, Journal Of Hand Surgery (British. 1991.
  • Wang WZ, Miller Crain G, Baylis W, Tsai TM. Outcome of digital nerve injuries in adults. J Hand Surg Am. 1996;21(1):138–43.
  • Dellon, A. L. Sensory recovery in replanted digits and transplanted toes: a review. Journal of reconstructive microsurgery. 1986;2(02);123-29.
  • Pettengill KM, Van Strien G. Postoperative management of flexor tendon injuries. In: Rehabilitation of the hand and upper extremity. 5th ed. 2002. p. 431–56.
  • Terzis, J., Faibisoff, B., Williams, B. The nerve gap: suture under tension vs. graft. Plast Reconstr Surg. 1975;56(2);166-70.
  • Wang F, Zhang R, Liu S, Ruan H, Xu J, Kang Q. Severe spaghetti wrist injury: Should we expand the terminology from wrist to proximal forearm? Jt Dis Relat Surg. 2022;33(2):273–84.
  • Widgerow AD. Full-house/spaghetti wrist injuries. Analysis of results. S Afr J Surg. 1990;28(1):6–10.
There are 32 citations in total.

Details

Primary Language English
Subjects Hand Surgery, Plastic Reconstructive and Aesthetic Surgery
Journal Section Research Article
Authors

İlker Altundağ 0000-0002-5827-3840

Murat Sinan Engin 0000-0003-0173-0411

Publication Date December 31, 2024
Submission Date July 7, 2024
Acceptance Date September 30, 2024
Published in Issue Year 2024 Volume: 41 Issue: 4

Cite

APA Altundağ, İ., & Engin, M. S. (2024). Crush versus sharp injuries in spaghetti wrist trauma: Analysis of 13 years of experience. Journal of Experimental and Clinical Medicine, 41(4), 707-712.
AMA Altundağ İ, Engin MS. Crush versus sharp injuries in spaghetti wrist trauma: Analysis of 13 years of experience. J. Exp. Clin. Med. December 2024;41(4):707-712.
Chicago Altundağ, İlker, and Murat Sinan Engin. “Crush Versus Sharp Injuries in Spaghetti Wrist Trauma: Analysis of 13 Years of Experience”. Journal of Experimental and Clinical Medicine 41, no. 4 (December 2024): 707-12.
EndNote Altundağ İ, Engin MS (December 1, 2024) Crush versus sharp injuries in spaghetti wrist trauma: Analysis of 13 years of experience. Journal of Experimental and Clinical Medicine 41 4 707–712.
IEEE İ. Altundağ and M. S. Engin, “Crush versus sharp injuries in spaghetti wrist trauma: Analysis of 13 years of experience”, J. Exp. Clin. Med., vol. 41, no. 4, pp. 707–712, 2024.
ISNAD Altundağ, İlker - Engin, Murat Sinan. “Crush Versus Sharp Injuries in Spaghetti Wrist Trauma: Analysis of 13 Years of Experience”. Journal of Experimental and Clinical Medicine 41/4 (December 2024), 707-712.
JAMA Altundağ İ, Engin MS. Crush versus sharp injuries in spaghetti wrist trauma: Analysis of 13 years of experience. J. Exp. Clin. Med. 2024;41:707–712.
MLA Altundağ, İlker and Murat Sinan Engin. “Crush Versus Sharp Injuries in Spaghetti Wrist Trauma: Analysis of 13 Years of Experience”. Journal of Experimental and Clinical Medicine, vol. 41, no. 4, 2024, pp. 707-12.
Vancouver Altundağ İ, Engin MS. Crush versus sharp injuries in spaghetti wrist trauma: Analysis of 13 years of experience. J. Exp. Clin. Med. 2024;41(4):707-12.